Overdose patients are sicker, ICU death rate increasing

Action Points

Deaths associated with opioid overdoses in hospital intensive care units nearly doubled over a seven-year period from 2009 and 2015, and the costs of treating overdose victims in the ICU has skyrocketed.

Note that the death rate among overdose patients treated in ICUs averaged 7% in 2009 and increased to 10% in 2015.

Deaths associated with opioid overdoses in hospital intensive care units nearly doubled over a seven-year period from 2009 and 2015, and the costs of treating overdose victims in the ICU has skyrocketed, researchers report.

The average cost of caring for an opioid overdose patient in the ICU increased by 58% from $58,500 to $92,400, according to a retrospective analysis of hospital billing records from 162 hospitals in 44 states.

Admissions to ICUs linked to opioid overdoses increased by 34% at the hospitals from January of 2009 to September 2015, according to the analysis appearing online in Annals of the American Thoracic Society.

Lead researcher Jennifer P. Stevens, MD, of Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, said the study is among the first to quantify the impact of the opioid epidemic on the nation's ICUs.

She said the findings highlight a "new level of crisis" associated with overdoses of prescription and illicit opioids.

"This study tells us that the opioid epidemic has made people sicker and killed more people, in spite of all the care we can provide in the ICU, including mechanical ventilation, acute dialysis, life support, and round-the-clock care," she said.

Stevens told MedPage Today that it is especially troubling that the death rate among overdose patients who make it to the ICU has increased so dramatically.

"These patients are coming in to ICUs with incredibly complex problems, and despite a very resource-intensive level of care we aren't able to save a lot of them," she says.

Stevens and colleagues examined a large, national database of hospital admissions. The main study outcome was validated ICD-9 admissions to the ICU for opioid-associated overdoses. Secondary outcomes included in-hospital death and markers of ICU resources.

From January 2009 to September 2015, there were 21,705 overdose admissions at the 162 hospitals requiring ICU care, representing 52.4 admissions per 10,000 ICU admissions during the seven-year period (95% CI 52.7-53.0 per 10,000 ICU admissions).

Multivariable modeling revealed that the number of hospitalizations for heroin overdoses each month was associated with an increase in monthly mortality among ICU patients with opioid-related overdoses (RR 1.247, 95% CI 1.137-1.368; P<0.001).

The number of patients admitted with overdoses from prescription drugs, however, was not significantly associated with ICU mortality from overdose (RR 1.031, 95% CI 0.992-1.071; P=0.125).

ICU admission due to overdose during the summer months was associated with lower mortality (RR 0.87, 95% CI 0.782-0.970; P=0.012).

"Our results provide the first description of the impact of the current opioid addiction crisis to the critical care community," Stevens and colleagues wrote.

"We would propose that any admission to the ICU for opioid overdose is a preventable admission. We have presented only one aspect of how healthcare systems interact with these patients, but critical care represents the most technologically advanced part of our care."

Stevens said it is not clear if the increase in ICU admissions is due to improved overdose treatment at the emergency response level.

She added that the role of the synthetic opioids fentanyl and carfentanil in increasing ICU admissions is also not well understood.

The researchers declared no funding sources nor relevant relationships with industry related to this study.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.